Voruganti Teja, Grunfeld Eva, Makuwaza Tutsirai, Bender Jacqueline L
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
J Med Internet Res. 2017 Oct 27;19(10):e366. doi: 10.2196/jmir.7987.
Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs.
The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools.
We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature.
We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14/47), nurses (23%, 11/47), and physicians (19%, 9/47), among others. Over half (52%, 25/48) of the tools were evaluated in randomized controlled trials, and 23 tools (48%, 23/48) were evaluated in nonrandomized studies. Terminology of tools varied by intervention type and functionality and did not consistently reflect a theme of communication. The majority of tools found in the Internet search were patient portals from 6 developers; none were found among published articles.
Web-based tools for text-based patient-provider communication were identified from a wide variety of clinical contexts and with varied functionality. Tools were most prevalent in contexts where intended use was self-management. Few tools for team-based communication were found, but this may become increasingly important as chronic disease care becomes more interdisciplinary.
慢性病患者需要持续护理，这不仅需要预约之外的医疗服务提供者的支持，还需要自我管理。基于网络的文本形式的医患沟通工具，如安全消息传递，允许在一个简单易用的媒介中共享背景信息和个人叙述，增强患者能力并使医疗服务提供者能够满足新出现的护理需求。
本研究的目的是：（1）系统检索已发表文献和互联网，查找基于网络的医患文本沟通工具；（2）梳理工具特征、预期用途、使用背景以及使用人群；（3）描述其评估性质；（4）了解描述这些工具的术语。
我们使用医学文献数据库（MEDLINE）和荷兰医学文摘数据库（EMBASE）进行了一项范围综述。我们总结了关于工具特征（结构、功能和沟通模式）、预期用途、背景和用户、评估（研究设计和结果）以及术语的信息。我们对互联网进行了平行搜索，以与已发表文献中确定的工具进行比较。
我们确定了54篇论文，描述了来自13个国家的47种独特工具，这些工具是在68种慢性健康状况的背景下进行研究的。大多数工具（77%，36/47）除了沟通功能外还有其他功能（如可查看的护理计划、症状日记或追踪器）。有8种工具（17%，8/47）被描述为允许患者与团队或多个医疗服务提供者进行沟通。大多数工具旨在支持关于症状报告（49%，23/47）以及生活方式或行为改变（36%，17/47）的沟通。使用工具与患者进行沟通的医疗服务提供者类型主要是各学科的专职医疗人员（30%，14/47）、护士（23%，11/47）和医生（19%，9/47）等。超过一半（52%，25/48）的工具在随机对照试验中进行了评估，2十三条工具（48%，23/48）在非随机研究中进行了评估。工具的术语因干预类型和功能而异，并未始终反映沟通主题。在互联网搜索中发现的大多数工具是来自6个开发者的患者门户网站；在已发表文章中未发现此类工具。
从各种临床背景中识别出了基于网络的医患文本沟通工具，其功能各异。工具在预期用途为自我管理的背景中最为普遍。发现的用于团队沟通的工具很少，但随着慢性病护理变得更加跨学科，这可能会变得越来越重要。
